Welcome to Delta Dental! 2021-22 Open Enrollment - A dental election is REQUIRED if you want dental insurance coverage for yourself and your ...
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Welcome to Delta Dental! 2021-22 Open Enrollment A dental election is REQUIRED if you want dental insurance coverage for yourself and your family in the new plan year!
The Delta Dental Difference® Delta Dental PPO Delta Dental Premier® Non–Delta Dental • Visit a PPO dentist to save the most. • You can visit any licensed dentist. • You won’t be charged more than your expected share of the bill.
Delta Dental PPO In-Network – & Premier PPODelta BASEDental PPO – PLANNon-Delta $75 perBASE PLAN person, Employee PPO Pays providers Employee Pays Diagnostic and Deductible $100 per person, Premier preventive Comprehensivecare year Per calendar 0%& Non-Contracted50% (exams, cleanings, orthodontics – CHILD 50% providers x-rays, ONLY sealants) Waived for D&P Basic services Comprehensive Annual maximum (Fillings, simple (Adult) Not covered 30% orthodontics 20%$1,500 per person extractions, root year Per calendar (after (after deductible) $1,500 Lifetime canals, gumMaximum deductible) Orthodontic treatment) $1,500 per person MajorLifetime maximum services 80% (Crowns, oral 70% (after surgery, bridges, (after deductible) dentures) deductible)
Your PPO coverage BUY-UP PLAN In-Network Premier & Delta DentalNon-Delta PPO PPO – BUY-UP PLAN Delta Dental Employee PaysPPO – $50 per person BUY-UP PLAN Deductible Diagnostic and Per calendar $150 per family preventive careyear 0% Employee Waived Pays 20% for D&P (exams, cleanings, Comprehensive Annual x-rays, maximum sealants) 50%person $2,000 per orthodontics Per calendar(child) Basic services year Comprehensive (Fillings, simple 20% Orthodontic extractions, root 50% 50% orthodontics (adult) Lifetime maximum $2,000 per (after deductible) person (after deductible) canals, gum Lifetime treatment)Maximum $2,000 Major services (Crowns, oral 50% 70% surgery, bridges, (after deductible) (after deductible) dentures)
DeltaCare® USA DHMO
The DHMO is available in the following states: • Alabama • New Jersey *The Delta DHMO is only available in approved • Arizona • New York states – the following are • Arkansas • North Carolina pending approval: • Delaware • Pennsylvania • California (pending) • Florida • South Carolina • Colorado (pending • Maryland (pending) • Illinois • Tennessee • Ohio (pending) • Indiana • Texas • Oregon (pending) • Kansas • Virginia • Washington (pending) • Michigan • Washington DC • Mississippi • Wisconsin • Missouri *Pending as of 12/14/2020
Comprehensive coverage DeltaCare USA DHMO: a prepaid, fixed copayment plan DHMOenrolled, Once benefit enhancements select a primary dentist from the DeltaCare USA include: network • 178tomore startcovered enjoying: DHMO • procedures; Set copays all-inclusive • copays No annual maximums •• Posterior composite fillings No deductibles covered • No claims • No missing tooth exclusion • Low premiums • Implants covered • Tooth whitening covered
How DeltaCare USA DHMO works Getting dental care is easy
Specialty and emergency care DeltaCare USA DHMO • If you need specialty care, your primary care dentist will refer you • Your primary care dentist requests authorization for specialty services • Plan includes out-of-network coverage for emergencies
All about braces DeltaCare USA DHMO • Orthodontic coverage for children and adults • All phases of orthodontic treatment are covered • Pre-and post-records • Tooth extractions • Coverage for in-progress treatment • Sampling of pre-set copays (please refer to full summary for additional details):
Teeth Whitening & Implants New with the DeltaCare USA DHMO DeltaCare USA Your copayment* Teeth Whitening External bleaching for home application, per arch; includes materials and $125 copayment fabrication of custom trays Implants Surgical placement of implant body: $1,005 copayment endosteal implant Custom fabricated abutment – includes $425 copayment placement Abutment supported porcelain/ceramic $740 copayment crown *Limitations and exclusions may apply. Sample listing of procedure codes. Please reference plan booklet for complete listing of covered procedure codes.
Go to deltadentalins.com to browse the DeltaCare USA dentists in your area. Write down the facility number of the primary care dentist you would like. Submit your request • Online: Create an online account at deltadentalins.com • By phone: Call Customer Service at 800-422-4234 Each member school will document dentist election and communicate to Delta Dental. If no election is made, a provider will be auto assigned. Providers can be changed anytime throughout the year.
Web and mobile resources
Sign up for an online account Check your benefits information online – deltadentalins.com • Check your plan details: eligibility, covered services and level of benefits. • Look up claim statements for recent dental visits. • View or print your ID card. • Estimate the cost of your next procedure. • Submit questions to Customer Service.
Go mobile What can you do with the app? To find the app, visit the App Store or Google Play and search for “Delta Dental.” Then download the Delta Dental app by Delta Dental Plans Association.
Find a network dentist • Go to deltadentalins.com. • Look for the Find a Dentist tab. • Search by name, address, landmark, city or ZIP code. • Select your network plan. • Click Search. • Narrow your search by location, specialty, network and language. • Your search results will include a dentist’s Yelp rating, address and phone number.
Cost Estimator Budget for dental expenses with personalized estimates Personalized. Estimates are based on your benefits, including maximums and deductibles. Insightful. Compare the cost of the same procedure at different dentists. Economical. See how choosing an in-network dentist can help you save.
Value Added Service: Savings you can hear! Access hearing aid and LASIK discounts Now available to you and your dependents Amplifon Hearing 62% average savings off retail Health Care hearing aid pricing 40-50% off traditional LASIK QualSight eye surgery
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